Overview: Mapping national EHRs in the Pacific Islands and Territories
National electronic health records (EHRs) promise to strengthen health systems by linking patient information across care settings and supporting policy decisions. In the Pacific Island Countries and Territories (PICTs), however, geography, workforce shortages, and limited infrastructure have historically constrained digital health progress. This environmental scan consolidates publicly available information from 14 World Health Organization Western Pacific SIDS, offering a first holistic view of national EHR status in the region and how it compares with global benchmarks.
What constitutes a national EHR in this context?
Using the World Health Organization’s Global Observatory for eHealth definition, an EHR is a real-time, patient-centered record that enables secure, authorized access to a person’s medical history across health facilities. A national EHR is typically implemented under the auspices of the national health authority and links care settings—from primary clinics to tertiary hospitals, laboratories, pharmacies, and emergency services. In PICTs, the landscape includes commercial and open-source solutions as well as country-led, bespoke systems.
Key findings: where the region stands
Across the 14 assessed PICTs, the scan found that 12 countries (86%) have some level of EHR implementation within the public health system. Eight of these countries have a single national system implemented at more than one facility, illustrating progress toward nationwide digital health records. By contrast, primary care facilities show substantially slower uptake, with EHR deployment most advanced in tertiary care settings. The region-wide picture shows:
- National EHRs present in 12/14 countries;
- Multiple countries reporting 100% coverage at tertiary facilities, but limited reach in primary and community settings;
- National coverage (across all facility levels) averaging about 33% (with a wide interquartile spread), and a median near 10% among the 12 countries with EHRs in operation;
- Facility-level breakdown revealing near-universal use in tertiary facilities (several countries reporting full coverage) while primary care facilities show minimal adoption (roughly 1–2% region-wide).
Systems in use include Tamanu, Medtech, Vesalius, PATIS Plus, and country-specific solutions. Notably, Tamanu is the only one currently listed as an approved Global Digital Good for Health, indicating its suitability for scaling in LMIC contexts.
Policy and strategic context
Policy readiness lags behind EHR rollout in most PICTs. Among the 14 countries, only Fiji had a publicly available, in-date national eHealth or health information system (HIS) policy or strategy during the period examined. Several others had related policies, but many were not current or publicly accessible. This disconnect between EHR deployment and formal digital health policy can hinder interoperability, governance, and sustainability if not addressed.
Regional implications: what this means for equity and care delivery
The EHR picture in PICTs underscores regional realities: geographically dispersed populations, variable connectivity, and limited infrastructure threaten national-scale rollouts. While tertiary care facilities may realize substantial benefits from digital records, primary care—often the most accessible point of care for many communities—lags behind. The scan highlights the need for EHRs that operate offline, are scalable, and can interoperate with other health information systems while maintaining data security and privacy. Open-source, fit-for-purpose solutions aligned with regional needs are recommended to support long-term sustainability and affordability.
Recommendations for sustaining and expanding national EHRs
To capitalize on momentum and improve consistency, governments and partners should:
- Prioritize open-source, scalable EHR platforms that can function offline and synchronize when connectivity allows;
- Adopt interoperable standards to enable data sharing across facilities and programs;
- Invest in governance, data quality, and privacy protections to build trust and sustainability;
- Coordinate with regional bodies (e.g., AeHIN, Pacific Health Information Network) and major development partners to standardize digital health metrics and reporting; and
- Promote visibility of national EHR status through a single, shared tracking mechanism to reduce duplication and improve decision-making.
Limitations and future directions
This environmental scan relies on gray literature and publicly available documents, which may not capture the most recent changes. Data gaps and the use of different denominators (facility counts) introduce uncertainties in national coverage estimates. Future work should include systematic, real-time monitoring of EHR adoption, impact assessments in relation to health outcomes, and clearer delineation between patient-level EHRs and other health information systems like DHIS2.
Conclusion
The environmental scan reveals that several PICTs have advanced toward national EHR coverage, including some with broad tertiary facility adoption. Yet primary care remains the main bottleneck, and policy frameworks lag behind rollout in most cases. A regional approach to tracking, investing in offline-capable, open-source EHRs, and strengthening governance will be essential to transform these early deployments into sustainable, nationwide digital health ecosystems that support better health outcomes across the Pacific Islands.
